by Georgia Center for Opportunity | Sep 29, 2014
Every Georgian is affected by the criminal justice system in some way. Whether it is paying taxes to fund the more than a billion dollars spent on prisons each year or knowing a loved one who has spent time behind bars, the justice system is becoming an increasingly familiar issue in the lives of Georgians.
In 2009, the Pew Center on the States released a report revealing that 1 in 13 adults were under some form of correctional supervision in Georgia. This means that over half-a-million Georgians were either in jail, in prison, on parole, or on probation that year. This percentage far surpassed the national average, which was still an astonishing 1 in 31 adults under correctional supervision.
Even more staggering, 2.6 million people have a criminal record on file with the Georgia Crime Information Center, while the state’s total population is 10 million people. The collateral consequences associated with having a criminal record mean that as many as 1 in 4 Georgians likely face barriers to obtaining employment, housing, and even voting.
Currently, 53,000 people are incarcerated in Georgia, giving the state the fifth highest prison population in the nation. The incarcerated population more than doubled between 1990 and 2011, while the state’s general population increased by only half that rate during the same time period.
The Merry-Go-Round
Once a person enters the system, his or her likelihood of staying in it is fairly strong. The state releases 20,000 prisoners back into the community every year, and 2 out of 3 of those released are rearrested within three years. Nearly 1 in 3 are re-convicted within this time frame, resulting in re-incarceration.
While the state reports a recidivism rate of 30 percent over the past decade (determined by the number of offenders who are reconvicted within three years of release), the actual recidivism rate is closer to 50 percent – taking into account the number of people who commit a technical violation while on probation and parole, as well as the number of offenders who recidivate after the standard three-year time period.
The Cost
The effect of recidivism is very costly to the state: It negatively impacts public safety, results in burgeoning costs to taxpayers, and contributes to the breakdown of families.
Public Safety
Released offenders who continue to have unaddressed criminogenic (crime-producing) needs are likely to re-engage in criminal behavior and place themselves, their families, and their community at risk. Criminal behavior may arise from a substance abuse or mental health issue, from negative peer associations, from a poor family environment, from desperation caused by their inability to meet their basic needs for housing, employment, and transportation, and from a variety of other risk factors. Without addressing the underlying factors that lead returning citizens to engage in criminal behavior, the recidivism rate will continue to remain high as new crimes and technical violations of probation and parole are committed.
Taxpayers
Recidivism places a heavy burden on taxpayers. The cost to incarcerate one person for a year in Georgia is $21,000 – more than twice the amount the state spends toward educating one student for a year. This means that every cohort of released prisoners that recidivates amounts to $130 million annually, given the 30 percent recidivism rate and the 20,000 offenders released each year. Further, state expenditures on incarceration reached $1.1 billion in fiscal year 2010 – more than twice the amount spent in 1990, which was $492 million. For the amount taxpayers have spent on the prison system in recent years, the outcomes have been unacceptable.
Families
Finally, a person cycling in and out of prison creates instability in the life of his or her family. Significantly, 60 percent of inmates in Georgia are parents, and a number of these parents have been incarcerated more than once. Children of incarcerated parents are more likely to perform poorly in school, to be exposed to their parent’s substance abuse, to use drugs, to experience mental health issues, to experience domestic violence, and to live in poverty. Incarceration puts a tremendous strain on existing relationships, decreases the chances that partners will marry, transforms family roles, and often leads custodial parents to depend on public assistance. Families experience shame, anger, hurt, and despair at the incarceration of loved ones, creating inner turmoil that is often never addressed.
What Can Be Done?
Because of the enormous costs posed by incarceration and recidivism, it is essential for Georgia to promote solutions that will address underlying issues returning citizens face. This effort must take place at all points along the continuum, from the Governor’s Office down to individuals in the community.
Several areas of reform that Georgia Center for Opportunity’s Prisoner Reentry Working Group has addressed to improve reentry outcomes involve increasing employment opportunities (read report), restructuring debt, and developing the criminal justice and service provider workforce.
Employment
Employment plays a critical role in reducing offender recidivism, as it has the power to deter ex-offenders from crime and incentivize law-abiding behavior. Key barriers to employment that the working group identified include driver’s license suspensions, missing identification (i.e., Social Security cards and birth certificates), professional license restrictions, and employers’ negative perceptions.
To remove these barriers, the group recommended that the state lift suspensions on driver’s licenses for people who committed a non-driving related drug offense, offer incentives to employers to hire those with a criminal record, and have public and private employers postpone the question about an applicant’s criminal history to a later point in the interview process. Several of these recommendations were signed into law in April 2014.
Debt
Various state agencies enforcing the payment of debts and obligations without considering the needs and financial circumstance of returning citizens can lead them to recidivate. Returning citizens often carry excessive debt because of missed child support payments that accrue during their incarceration, court-imposed fees, fines, and surcharges for their offense, unpaid restitution, and the inability for them to earn money while in prison.
Several steps that the state can take to encourage returning citizens to repay this debt in a realistic manner include: Identifying offenders with child support orders upon entry to prison; providing offenders with pertinent information about their child support responsibilities; providing a grace period of 90 days upon release that gives returning citizens the opportunity to find a job and get back on their feet; and providing incentives for returning citizens to pay current obligations of child support and restitution by forgiving a portion of fines, fees, surcharges, and child support arrears owed to the state.
Workforce Development
There is an urgent need for the criminal justice workforce and community service providers to be trained in delivering evidence-based programs and practices. Without proper training and implementation, Georgia’s recidivism rate is likely to remain unchanged.
The state can better ensure successful reentry outcomes are reached by providing training and support to agencies and service professionals in the use of evidence-based practices, developing a hybrid degree program that combines criminal justice training and case management techniques, ensuring a risk/needs assessment is used and followed from entry into prison to treatment in the community, providing the workforce the ability to use graduated sanctions and incentives, and providing accountability to the workforce to ensure evidence-based practices are being used.
Conclusion
Each person involved with this reentry effort, from the governor to mentors in the community, need to put into practice what has shown to work in reducing recidivism. This effort will require education, training, resources, and coordination on all fronts, and it is one that should be pursued with fidelity. Doing so will help to bring restoration to families, build stronger communities, and ensure a more just society.
Click here to view The State of Corrections infographic
by Georgia Center for Opportunity | Aug 25, 2014
Image retrieved from iamgifted.org.
Georgia Center for Opportunity (GCO) desires to see students flourish. As a way of realizing this vision, GCO supports organizations that have a similar heartbeat to see students succeed. One such organization is the Gifted Education Foundation (Gifted).
This summer, GCO had the privilege of hosting Gifted’s founder, Anthony Flynn, for a Lunch & Learn where he discussed how Gifted got started and the impact it is making in the community. Local high school students, education leaders, and various non-profit workers came to the event to learn more about this promising organization.
Flynn opened the session by sharing an inspiring testimony about his life.
Born to a 17-year-old single mother in Memphis, Tennessee, his childhood was marked by upheaval and transition. Nonetheless, he overcame adversity and earned a scholarship to play football at Tennessee Tech University. College proved to be another period of trials, however, as he found himself surrounded by peers who made negative choices. After attending this school for just a semester, he decided to transfer to the University of Memphis where he would go on to graduate in four years.
After graduating from college, Flynn continued his education and earned a Master of Arts (Religion) from Memphis Theological Seminary. During this time, he worked as a student pastor where he served and mentored many at-risk students. This work led him to become involved in sustainable urban development that focused on restoring the economic, educational, and social foundation of his community, and later to serve as president of a national organization that trains urban leaders to impact America’s 250 most at-risk zip codes. From these experiences, Flynn went on to found Gifted in 2012.
Gifted exists to produce first generation college graduates and marketplace leaders from low-income communities across America. It is built upon the premise that every child has the potential to succeed if given the opportunity and guidance he or she needs.
Image retrieved from iamgifted.org.
Flynn believes that although “16 million American children are growing up in poverty,” they do not have to stay there. They can move forward “with the right educational opportunities and a structured system of leaders guiding them through a proven process.”
Providing this opportunity and guidance is precisely what Gifted seeks to do.
As a way of accomplishing this mission, Gifted has developed a four-phased strategy. Each phase prepares students for their next step in life, equipping them with the skills and resources needed to maximize their potential:
Phase 1: The Gifted Preparatory School
The first phase of the strategy involves preparing high school students for college, careers, and the rest of their life by teaching them general life skills, improving their ability to take standardized tests, building college and career awareness, and directing students toward scholarship and financial aid options.
Phase 2: The Gifted College Access Program
The second phase is designed to serve a select group of students who receive comprehensive life skills development and college readiness training. This training occurs on a college campus throughout students’ junior and senior years of high school. The focus is on improving their writing and standardized test-taking abilities, guiding them through the college application process, scholarships and financial aid, and strengthening their life skills in the realm of decision-making, conflict resolution, and time management, among others.
Phase 3: The Gifted Mentoring Program
The third phase provides students who successfully complete the Gifted College Access Program with hands-on, experiential coaching through the Gifted Enrichment and Retention Curriculum. Each student is assigned to a Life Development Coordinator and placed in cohorts where life-on-life accountability and support is deliberated throughout their entire undergraduate education. Students will also participate in leadership development programs, internships, fellowships, and research graduate school options.
Phase 4: The Gifted Leadership Program
Finally, the fourth phase consists of two tiers:
The first tier will provide college graduates with a key marketplace partner who will serve as a life and career mentor. Graduates will work to develop short, medium, and long-term goals in a variety of life categories. In addition, they will cultivate leadership skills, work to enhance existing relationships, and develop a civic and community engagement plan.
The second tier is for graduates who have the criteria in place to become marketplace leaders. They will receive preparation for mid-level to senior-level executive leadership roles in the marketplace, mentor at least one student in the Gifted program, receive training and opportunity for philanthropy and high-impact community involvement, and be trained to serve as entry-level board members for community and non-profit organizations.
Image retrieved from http://iamgifted.org.
Through the implementation of this strategy, Gifted hopes to achieve three outcomes over the course of a student’s involvement with the program. The first is that Gifted students graduate high school equipped with academic and life skills necessary to enroll in and be successful at a four-year college/university. The second is that Gifted students graduate college and are successfully hired in the marketplace or enrolled in graduate school within six months of college graduation. The third is that Gifted alumni take on the responsibility of mentoring at least one other student within six months of their graduation.
Cultivating the mentality of giving back is important for the continued success of the program and for growing lifelong, benevolent people that will continue to serve their communities.
Gifted’s comprehensive approach prepares students to be successful in college, in their career, and in life. For this reason, GCO is proud to encourage community partners to support Gifted in seeing students reach their full potential.
To learn more about Gifted, get involved with their work, or read stories about their success, visit http://iamgifted.org/.
by Georgia Center for Opportunity | Aug 22, 2014
A word from our CEO, Randy Hicks
Election years get noisy, don’t they? Perhaps it’s just me, but they actually seem to be getting noisier with every election cycle.
On the brighter side, election years always remind me of why the Georgia Center for Opportunity’s policy work is so important: Politicians come and go but GCO is always here, contending for the things you care about, no matter who’s in public office.
That’s what we’ve been up to this election year – working on what matters to you. And because you’ve been a friend of the Georgia Center for Opportunity, I’d like to update you on our work over the past few months.
I am also writing to ask you to renew your support for the Georgia Center for Opportunity by continuing to invest in our work – and by taking advantage of the opportunity to double your gift. We can’t do any of this without you!
As you know, the Georgia Center for Opportunity believes that one of the defining ideas of America is a nation where everyone has an opportunity to achieve a better life. Like you, we believe that people from all walks of life should have the chance to succeed through talent and hard work, regardless of the circumstances of their birth.
GCO’s mission is to remove barriers to that kind of opportunity in Georgia.
The barriers we remove include those that interfere with healthy family formation, that limit access to quality education, and that promote dependency rather than self-sufficiency. Sometimes those barriers are personal, other times they’re cultural, and still other times they’re governmental. Our work takes aim at those barriers. For example, in recent months GCO has:
- Published a report with recommended alternatives to Medicaid expansion that would increase Georgians’ access to quality healthcare.
- Produced prisoner reentry policy recommendations that were signed into law and adopted by the Governor’s office that increase the likelihood of ex-offenders finding and maintaining work, a key successful reentry and public safety.
- Incubated Breakthrough Ambassadors, a community-based, mostly student-led program that prepares students for success both academically and professionally.
Here’s a deeper look at those issues and why GCO tackled them:
Charity Care as an Alternative to Medicaid Expansion
Given the constant fiscal crisis in Washington, it is our view that states must start finding creative ways to help those in need without looking to the federal government for help. And we recognize that some of the most compelling alternative solutions are developed at the community level, not in government offices.
For the past several months, much of GCO’s research has been focused on identifying ways we, as a state, can provide healthcare access for individual, poor, uninsured Georgians without expanding Medicaid under the Affordable Care Act (ACA).
In the process, we found local, sustainable ways to address the problem at a fraction of the long-term costs associated with the ACA. We propose reforms that will offer better health outcomes and stabilize financial burdens for Georgia families while maintaining responsible and sustainable levels of government spending. One of the best ways to meet the need for access to healthcare is Georgia’s charity-care network.
In 2012, Georgia’s charity clinics served nearly 200,000 individuals and saved the state over $200 million. They did all this without any support from the state. But with relatively modest support from the state – and some other changes to various laws and regulations – the charity care network could serve hundreds of thousands more. (You may access the report at www.foropportunity.org/assets/Charity-Care-Report.pdf.)
Our next step is to education lawmakers about the steps they must take to serve individuals and families who may not have access to quality care.
Prisoner Reentry
Georgia’s incarceration rate is the highest in the country: about 1 in 13 Georgians are under some form of state supervision, versus 1 in 31 nationally. That’s a staggering difference. And between 1990 and 2011, Georgia’s prison population more than doubled to nearly 56,000 inmates. State spending on corrections soared as well, from $492 million to more than $1 billion annually. Despite this substantial investment, Georgia’s 30% recidivism rate had remained virtually unchanged for a decade.
Simply put in terms of dollars and cents, Georgia cannot afford these costs. But more importantly, we cannot afford the tragic human costs.
So, think about this: If we reduced the rate at which ex-offenders lapsed into criminal behavior by a very doable 10 percent, we would reduce the state costs of incarceration by $60 to $70 million per year. But more to the point, that ten-percent reduction would represent about 2000 ex-offenders who will have successfully reentered society, likely found employment, and quite possibly reconnected with their families in positive ways. That’s a pretty large-scale win-win!
You see, through our experience working to strengthen families, we have seen the social problems that arise from parents cycling in and out of prison. We have seen the impact this instability can have on children’s intellectual, social, and emotional development. And we have seen ex-offenders working hard to overcome barriers to successful reentry.
Over recent months, through our research and work with prisoner reentry experts, we have proposed and successfully advocated for solutions to remove unnecessary barriers to reentry. As I said, three of those policy recommendations were signed into law in April, and two additional recommendations were adopted by the Governor’s office.
The formula was this success? Excellent research, expert partners and effective advocacy. That’s what we do.
A Community Focus: Breakthrough Ambassadors
GCO remains a leading advocate for school choice in Georgia. In recent years, we helped lead the charge to create Georgia’s Special Needs Scholarship and Tuition Tax Credit programs; and more needs to be done to increase access to quality education. But we also recognize that it’s important that our public schools perform well, and that a higher percentage of kids in those schools graduate and get on the path toward a productive and satisfying life.
To that end, GCO created and launched Breakthrough Ambassadors, which is a mentoring program that provides high school students with service and leadership opportunities designed to enhance post-high school success. The current pilot program was created to support the Breakthrough Norcross initiative that has an overarching goal to increase the number of Norcross Cluster students who graduate from high school.
More than 120 Norcross HS students are now participating in programs and events that expose them to various colleges, career paths, and service opportunities and assist them in improving academic performance.
In the coming years, we will be replicating the program in communities around the state, so that many more students will have the opportunity to succeed.
As you can see, we’ve been quite busy. Which is exactly how we like it.
We are grateful for men and women like you who support our work, invest in the future of Georgia, and make our success possible.
Your renewed support for the Georgia Center for Opportunity will help us continue to do the kind of work I’ve described, work that’s designed to remove barriers to opportunity so that all Georgians – and Georgia’s families – have a real chance to prosper.
Will you please consider making a special gift $75, $150, $250, or even as much as $500, $1000 or whatever your means allow. And thanks to the generosity of a key GCO supporter and the GCO board, any gift given between now and August 31st will doubled.
Thank you for your investment in GCO’s mission and work.
You may make a secure donation online here.
by Georgia Center for Opportunity | Jul 24, 2014
This is the sixth entry in a series of posts highlighting GCO’s new report – Increasing Access to Quality Healthcare for Low-Income Uninsured Georgians. The first entry provided an overview of the report, the second looked at Georgia’s healthcare safety net, the third explained the impact of uninsurance, the fourth focused on Medicaid and the Affordable Care Act, and the fifth highlighted challenges to expanding access to healthcare.
While there are significant challenges to providing low-income uninsured Georgians with quality healthcare, there are cost-efficient, state-based solutions Georgia can implement in the short-term that can positively impact health outcomes for Georgians in the coverage gap.
Provide State Government Support for Georgia’s Charity Clinics
The state’s 96 clinics served more than 183,000 unique patients and saved the state over $200 million in 2012 while not receiving any state funding. However, other state governments do financially support their charity clinics. Virginia provides $3.5 million to its 53 clinics; Ohio gives $435,000 for 46 clinics; West Virginia provides $4.3 million to 11 clinics; and South Carolina recently approved $2 million for 51 clinics.[i]
The state’s existing charity clinics have the capacity to serve more patients, but funding and unnecessary state restrictions limit their ability to meet their full potential. The Georgia Charitable Care Network requested a $2 million appropriation from the Georgia legislature in 2014.[ii] Since clinics’ can provide $7 worth of services for every $1 spent, this relatively small amount of government funding would allow clinics to be open more hours and serve an estimated 100,000 additional patients.[iii] With the increase in funds, the expansion in capacity could take place at many clinics with little delay, providing much needed care to Georgia’s most vulnerable citizens. However, funding for Georgia’s charity clinics was not included in the state’s FY 2015 budget.
While a $2 million appropriation would allow Georgia’s current clinics to serve more patients, over 40 percent of counties do not have a charity clinic. A larger appropriation would allow for the Georgia Charitable Care Network to help underserved communities open new clinics. Since many rural areas have limited access to care, new clinics could have a significant impact on communities across the state.
In 2015, the state should provide $10 million in funding to support the dramatic expansion of current clinics and the creation of new ones in underserved communities. Compared to the $2.1 billion cost of Medicaid expansion over ten years, this appropriation is affordable for the state and sustainable in the long-term while still expanding access to quality healthcare to a significant portion of the state’s low-income uninsured population.
Expand Telemedicine into Charity Clinics
Telemedicine is the provision of care through real-time interactive communication between the patient and provider from one site to another via electronic communications. The electronic communication – which usually includes at least video and audio – allows a provider to care for a patient at a different location. Telemedicine can be used to provide primary and specialty care, remote patient monitoring, and medical education. Care through telemedicine can take place at hospitals, clinics, community health centers, nursing homes, and schools.[iv]
Telemedicine has improved access to care for many individuals – especially those in rural areas that have a physician shortage – because instead of traveling across the state to see a provider, a patient can go to a local clinic or hospital and be connected with a provider located anywhere in the state. Telemedicine has been shown to reduce the cost of healthcare and increase efficiency through better management of chronic diseases, reduced travel times, shared health professional staffing, and fewer or shorter hospital stays.[v]
Georgia has one of the most robust and developed telemedicine networks in the country, but Georgia’s charity clinics are not currently using telemedicine. Utilizing telemedicine in the clinics would enhance their ability to deliver services. Setting up telemedicine presentation sites in charity clinics would allow providers to volunteer their time at clinics across the state without leaving their office. This would be especially beneficial to individuals who live in rural areas and often do not have access to specialty care.
Charity clinics currently do not have the capital to purchase the technology and infrastructure required for telemedicine, which is relatively inexpensive given the benefit it provides.[vi] The Georgia legislature should include funding to pilot the use of telemedicine in its charity clinic appropriation.
Modernize Nurse Practitioner Laws and Regulations
Many nurse practitioners and other mid-level providers deliver care to patients at charity clinics as employees or volunteers. However, the ability of NPs to provide care is limited by Georgia’s restrictive laws and regulations.
Georgia should join the one-third of states that provide full practice authority to NPs. By implementing the licensing model recommended by the National Council of State Boards of Nursing and the Institute of Medicine, NPs will be able to provide the high level of care that they are educated and prepared to provide at charity clinics and other healthcare facilities across the state.[vii]
While many physician associations have opposed these reforms, a 2012 study found no evidence of differences in primary care physician earnings between states that provide NPs with full practice authority and those that maintain practice barriers.[viii] Since the literature on NPs finds no reason to be concerned with the quality of care provided by NPs and it should not impact Georgia’s physicians’ earnings, there is little to no reason for the state to continue to limit the care NPs can provide.
Reinstate Sales Tax Exemption for Charity Clinics
Many healthcare providers are exempt from the payment of Georgia’s sales and use tax, including licensed nonprofit in-patient general hospitals, mental hospitals, nursing homes, and hospices.[ix] From 2008 to 2010, Georgia’s volunteer health clinics were also exempt from Georgia sales tax on medical and office supplies and other purchases.[x]
Given the amount and quality of care charity clinics deliver and the savings this care provides to the state, Georgia should reinstate the sales tax exemption to provide the clinics with more resources to serve individuals in need of care.
Replace the Lost Federal DSH Funds with State Dollars
Many hospitals have expressed concern about the upcoming loss of DSH funds. In 2016, Georgia hospitals will lose an estimated $26 million in federal funds for uncompensated care. The federal funding loss increases to $40 million in 2017 and $111 million in 2018.[xi]
DSH funds are an important source of revenue for many of the state’s hospitals, and the federal reduction could cause some of the hospitals to cut services or completely close. To support this essential component of the state’s safety-net, the state should replace the lost federal funding. Since implementing the above recommendations to support the state’s charity clinics and other state and federal health policies could reduce the amount of uncompensated care provided by hospitals, the state may not need to replace the full amount of lost federal funding. Thus, the state should work with hospitals to identify the amount of uncompensated care they provide and to calculate the amount of state funding needed for hospitals to maintain services.
[i] Georgia Charitable Care Network, “Partners in Georgia’s Safety Net.”
[ii] John Sparks, “Stabilizing the Healthcare Safety Net: A Partnership with Free and Charitable Clinics,” Georgia Charitable Care Network, Presentation to Georgia General Assembly Joint Study Committee on Medicaid Reform, November 18, 2013, video of testimony found at http://www.house.ga.gov/Committees/en-US/MedicaidReform.aspx.
[iii] GCO interview with Donna Lopper, Georgia Charitable Care Network, December 9, 2013.
[vi] GCO interview with Jeffrey Kesler, Georgia Partnership for Telehealth, March 13, 2014.
[xi] Georgia Hospital Association, Hospitals 101, 28.
by Georgia Center for Opportunity | Jul 22, 2014
This is the fifth entry in a series of posts highlighting GCO’s new report – Increasing Access to Quality Healthcare for Low-Income Uninsured Georgians. The first entry provided an overview of the report, the second looked at Georgia’s healthcare safety net, the third explained the impact of uninsurance, and the fourth focused on Medicaid and the Affordable Care Act.
Georgia faces many challenges and barriers to expanding access to quality healthcare for low-income uninsured individuals, particularly for those in the Medicaid expansion coverage gap.
State Fiscal Constraints
Preliminary estimates projected that providing Medicaid to newly eligible adults through the expansion would cost the state approximately $2.1 billion from 2014 to 2023. Since the federal government covers 100 percent of the cost for the first three years and then slowly reduces its contribution until it is set at 90 percent in 2020, expansion is projected to first cost the state about $120 million in 2017. In 2023, the final year of the projection, state costs will have risen to almost $406 million.[i]
Governor Deal and other state leaders maintain that the state cannot afford Medicaid expansion and have expressed serious concerns that the federal government will be unable to live up to its obligations under Medicaid expansion. Therefore, any policy or program that would improve access to healthcare for low-income uninsured Georgians must cost significantly less than Medicaid expansion and must rely upon state-based sources of funding.
Physician Shortage
Georgia ranked 41st in the country in active physicians and 44th in primary care physicians per capita in 2010.[ii] According to the U.S. Department of Health & Human Services, almost 2 million Georgians live in a “Primary Care Health Professional Shortage Area,” meaning there are a low number of primary health professionals relative to the population.[iii] In 2010, 31 of Georgia’s 159 counties did not have an internal medicine physician; 63 did not have a pediatrician; 79 did not have an OB/GYN; and 66 did not have a general surgeon.[iv]
Georgia’s Fiscal Year 2015 budget allocates $2 million in additional funds to develop new graduate medical education programs to train residents.[v] While an important step, the state must continue to pursue efforts to address its shortage of primary care providers. Without more providers, many Georgians may not have access to primary care, even if they have health insurance coverage.
Limits to Nurse Practitioner Scope of Practice
Nurse practitioners (NPs) are an important provider of primary care across the country. In many states, NPs evaluate and diagnose patients, order and interpret diagnostic tests, and initiate and manage treatments. A literature review by the National Governor’s Association found that most studies show that NPs provide comparable care to physicians and achieve equal or higher satisfaction rates among their patients. The review did not find any studies that raised concerns about the quality of care offered by NPs.[vi]
Georgia’s laws and regulations for NPs are more restrictive than almost any other state. A 2007 study ranked Georgia’s NP regulations 48th in the country because the state’s NP limitations affect patients’ freedom to choose providers and NPs ability to provide primary care.[vii] Georgia’s restrictions include requiring NPs to be supervised by a physician and to have a collaborative agreement with a physician or a physician’s supervisor/delegation in order to prescribe drugs. These limitations do not exist in over one-third of states.[viii]
Fiscal Challenges of Safety-net Hospitals
Hospitals that serve a large number of Medicaid and low-income uninsured patients receive state and federally funded supplemental payments from state Medicaid programs. Called disproportionate share hospital (DSH) payments, the funding offsets the disadvantaged financial situation of hospitals that provide large amounts of uncompensated care to uninsured individuals and serve a substantial number of patients in the relatively low-paying Medicaid program.[ix]
The ACA was expected to reduce the number of uninsured individuals and, therefore, reduce hospital uncompensated care costs. This would create less need for DSH payments. Thus, the ACA required annual aggregate reductions in federal DSH funding from FY 2014 through FY 2020.
In 2011, almost 40 percent of Georgia hospitals lost money. Rural hospitals are in an even worse financial situation as 55 percent had negative total margins.[x] Given their financial struggles, Georgia hospitals have expressed concern regarding the DSH reduction. Since Georgia does not plan to expand Medicaid, the reduction in DSH payments would not be offset by an increase in revenue through having more patients being covered by Medicaid. Thus, the hospitals are likely to receive less funding, while the demand for uncompensated care is expected to persist.
[i] Georgia Department of Community Health, “Preliminary Estimate on the Impact of Federal Health Care Reform on the Georgia’s Medicaid and PeachCare Program,” Handout, April 2012.
[v] Governor Nathan Deal, Office of the Governor, “Deal: Budget includes half a billion dollars in k-12 education,” Press Release, April 28, 2014, accessed May 23, 2014, https://gov.georgia.gov/press-releases/2014-04-28/deal-budget-includes-half-billion-dollars-k-12-education.
